Healthy School Food Guide for Implementation - FY2014-15 - Minnesota Department of Health Statewide Health Improvement Program

 
Healthy School Food Guide for Implementation - FY2014-15 - Minnesota Department of Health Statewide Health Improvement Program
Minnesota Department of Health
Statewide Health Improvement Program

         Healthy School Food
       Guide for Implementation
              FY2014-15
Healthy School Food Guide for Implementation - FY2014-15 - Minnesota Department of Health Statewide Health Improvement Program
Healthy School Food – last updated 6/2013

Contents
Description of Strategy ....................................................................................................... 3
Priority Populations ............................................................................................................ 3
Scope of Strategy ................................................................................................................ 4
   Outputs ........................................................................................................................... 6
   Outcomes ........................................................................................................................ 6
   Indicators ........................................................................................................................ 7
Requirements ...................................................................................................................... 7
Recommended Partners ..................................................................................................... 8
Training and Technical Assistance ...................................................................................... 8
Appendices.......................................................................................................................... 8
       A: Dietary and School Food Guidelines: Information and Resources ....................... 10
       B: Local Wellness Policy Requirements and Planning for Sustainability .................. 12
       C: School Health Councils.......................................................................................... 15
       D: Action Plan Template – Sample for School Teams ............................................... 18
       E: Healthy School Food Work Plan............................................................................ 19
       F: Farm to School Guide to Implementation ............................................................ 21
       G: Healthy School Food Options: Outside of the USDA Reimbursable Meal Program
       Guide to Implementation ......................................................................................... 27
References ........................................................................................................................ 33

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Description of Strategy
Today, more than 23 million children and adolescents in the United States, nearly one in
three young people, are overweight or obese. With the obesity epidemic comes an
increased risk of a variety of chronic health problems, impacting young peoples’ lives
and straining the healthcare system.1 Since approximately 95 percent of youth in the
United States attend school, schools are an important setting in which to model healthy
eating.

On average, students consume 35 percent to 50 percent of their daily total calories at
school.2 However, within the school setting youth are often given access to junk foods
and sugary drinks that offer little nutritional value. Some of this access is through
competitive foods. Competitive foods and beverages include all items served or sold in
schools outside of the federally reimbursable meal programs. Typically, these
competitive products are sold in vending machines, a la carte lines within cafeterias,
school stores, and snack bars. Recent studies show that approximately 40 percent of
students buy and eat one or more snacks at school and 68 percent buy and consume at
least one sugary drink.3 Several studies have linked competitive foods and beverages
with excess calorie consumption and obesity among school-age children.

In 2010, the Healthy, Hunger-Free Kids Act (HHFKA) was passed with the goal of
providing healthier foods and beverages in schools.4 This was the first time in over thirty
years that nutrition standards for school foods were updated. The HHFKA required that
the USDA update nutrition standards for the School Breakfast Program and National
School Lunch Program, and update nutritional standards for snack foods and beverages
that are available on school campuses during the school day. The final rule was
published for the School Breakfast Program and National School Lunch Program in 2012,
and proposed standards for all snacks were released in February of 2013. Prior to this
time, nutritional standards for all foods available on school campuses were determined
at the local level as Minnesota has no established competitive food guidelines at the
state level. Research shows that standards must be comprehensive in scope to improve
children’s diets and help prevent obesity.

It is the goal of this strategy, Healthy School Food Options, to increase fruit and
vegetables and decrease sodium, saturated fat, and added sugars in foods available
during the school day on school campuses. Evidence-based strategies to reach these
goals include Farm to Fork, nutrition literacy components, establishing and
implementing standards for all foods sold on school grounds within the school wellness
policy, and more.5 6

Priority Populations
Schools that have a high percentage of free and reduced meal eligibility should be
targeted, concentrating on schools that have 50 percent eligibility or greater. To access

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data on individual school eligibility information (not the whole district) visit:
http://education.state.mn.us/MDE/SchSup/FNS/SFSP/Elig/index.html.
The document is titled, Public School List with Percentage of Free and Reduced-Price
Lunch Students Used for Eligibility Determinations.

Scope of Strategy
The scope of the Healthy School Food Options strategy includes creating sustainable
policy, systems, and environmental change by increasing access to healthier options and
decreasing access to unhealthy options, enhancing health literacy to school decision
makers (providing professional and skill development trainings leading to practice
change), and by changing policy at the local level. All healthy eating initiatives should
focus on the following four goals: increasing access to fruits and vegetables, decreasing
access to foods high in sodium, saturated fat, and added sugars.

The work of the Physical Activity and Nutrition Unit (PAN) at the Minnesota Department
of Health is depicted in the graphic on the following page.

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Figure 1: PAN Commitment Infographic

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Outputs
Phase 1 – Partnerships and Planning

      Required – Review literature and resources on dietary guidelines - see Appendix
       A for Dietary Guidelines
      Required – Review literature and resources on Local Wellness Policy
       Requirements – see Appendix B for Local Wellness Policy Requirements
      Required – Attend or convene a school health council meeting-see Appendix C
       for more information and guidance on School Health Councils
      Required – Review existing nutrition policies and practices for school(s)/district
      Required – Conduct an initial school food environment assessment (tool to be
       completed by MDH Evaluation)
      Review action plan as identified in the RFP for Healthy School Food Work Plan –
       see Appendix E for Healthy School Food Work Plan
      Required – Action plan outlined- see Appendix D for sample Action Plan
      Define common goals, identify key stakeholders, and assign roles/responsibilities
      Review existing implementation guides for strategies that school health councils
       would like to pursue, if applicable – see Appendix F for Farm to School Guide and
       Appendix G for Healthy School Food Options Outside of the USDA Reimbursable
       Meal Program

Phase 2 – Growth

      Required – Implement action plan – see Appendix D for sample Action Plan
      Engage key stakeholders and decision makers in implementation
      Identify professional development and skill training needs
      Conduct or arrange for trainings
      Enhance practices with health literacy (educational components) of healthy
       eating strategies

Phase 3 – Innovation and Promising Practices

      Grantee will determine and provide lessons learned to other grantees

Outcomes
Short-Term, Mid-Term, and Long-Term Outcomes

Short-Term Outcomes:

      Relationship is established and strengthened between local public health and
       school partners
      Knowledge of policies, practices, and attitudes regarding healthy eating are
       discussed

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      School decision makers are informed of key findings and are engaged in action
       plan development

Mid-Term Outcomes:

      Healthy eating practices within the school are implemented
      Healthy eating policies are implemented and/or enforced
      Access to fruits and vegetables is increased
      Intake of foods high in sodium, saturated fat, and added sugar is decreased
      Health literacy (educational components) has increased

Long-Term Outcomes:

      Students and staff eat more fruits and vegetables
      Students and staff eat decreased amounts of sodium, saturated fat, and added
       sugars

Indicators
MDH Evaluation to make final determinations--information forthcoming

Requirements

      Review Dietary Guidelines- see Appendix A for more information on Dietary
       Guidelines
      Review Local Wellness Policies for school(s)/district sites – see Appendix B for
       more information on Local Wellness Policy Requirements
      Attend or convene a School Health Council meeting – see Appendix C for more
       information on School Health Councils
      Complete an initial school-wide needs assessment with aid from the School
       Health Council
       *Recommended tool – School Health Index (SHI)
       The School Health Index is a self-assessment and planning tool that enables
       schools to identify the strengths and weaknesses of the school’s policies and
       programs that promote health and safety. The SHI has an Elementary and
       Middle/High School version. Both versions are available free of charge, online
       and in print form. The SHI consists of eight self-assessment modules and a
       planning for improvement process. The assessment process involves members of
       the school community, parents, students, tribal council and the community to
       improve school policies, programs and services. The SHI is a nationally
       recognized, researched-based assessment tool recommended by the CDC. Many
       schools are familiar with this tool. Training for the proper use of the SHI will be
       available through the MN Department of Education upon request.
       http://www.cdc.gov/healthyyouth/SHI/index.htm

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       Conduct a baseline school food environment assessment (tool is forthcoming)
       Action plan outlined addressing all four goal areas of increasing fruits and
        vegetables, decreasing sodium, saturated fat, and added sugar. See Appendix D
        for sample action plan template and planning calendar.
       Continue to modify and update Healthy School Food Work Plan and
        communicate with assigned Community Specialist at MDH – see Appendix E for
        Healthy School Food Work Plan

Recommended Partners
A best practice for working in schools is to convene a school health council/team.
Having a broad base of internal stakeholders will move the work along more quickly and
efficiently. The school health council should include various professionals and decision
makers, including, but not limited to: administrators, physical education teachers,
health teachers, classroom teachers, school support staff, food service staff, school
nurse, parents, students, and community members.

Training and Technical Assistance
All trainings will be posted on the Basecamp calendar and in SHIP’s weekly newsletter,
Making It Better: Minnesota’s Health Improvement Log. More information will be
forthcoming. Please refer to the SHIP 3 Guide to Training and Technical Assistance for an
overview of all training and TA.

       Required – A two-hour virtual training kick-off for school setting strategies
        planned for local public health. Topics include engaging schools, required
        assessments, clarifying what technical assistance is available, setting up sharing
        networks, and outlining resources. Two options tentatively planned for fall of
        2013.
       Regional workshop (approximately one per year)
       School Health Index training on request
       Monthly strategy specific phone call/webinars (topics/dates to be released on
        September 1, 2013)
       Timely resources shared via Making It Better: Minnesota’s Health Improvement
        Log

Appendices
   A.   Dietary and School Food Guidelines: Information and Resources
   B.   Local School Wellness Policies: Background Information and Resources
   C.   School Health Councils: Information and Resources
   D.   Action Plan Template- sample for school use
   E.   Healthy School Food Work Plan- for local public health use
   F.   Farm to School - Guide to Implementation and Resources

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   G. Healthier School Food Options Guide - Guide to Implementation and Resources

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Appendix A

A: Dietary and School Food Guidelines: Information and Resources

Background: Competitive Foods
Competitive foods are defined by the USDA as foods and beverages, regardless of
nutritional value, sold at school separate from the USDA school meals program. These
foods are typically available in school stores, vending machines, and a la carte lines.
Currently, in Minnesota there is no standard for competitive food guidelines. However,
the Healthy, Hunger-Free Kids Act requires the USDA to issue healthy nutrition
standards for all foods sold in schools with the goal of eliminating unhealthy foods.
These standards were proposed in February of 2013; however, the final rule for this
federal legislation has not yet been released. For more information, please see the
literature and resources below. Districts can have nutrition standards that exceed the
federal rules, both before and after new rules are implemented. Schools are encouraged
to stay abreast of the new USDA rules and requirements.

Literature and Resources
     2010 Dietary Guidelines for Americans
       http://www.health.gov/dietaryguidelines/2010.asp
       Also, check out ChooseMyPlate educational resources that align with the dietary
       guidelines http://www.choosemyplate.gov/.
     USDA Healthy, Hunger-Free Kids Act
       “Nutrition Standards for All Foods Sold in School” has not been released at time
       of press; however, the proposed rule was released in February of 2013 and final
       rule should be forthcoming.
       http://www.fns.usda.gov/cnd/Governance/Legislation/CNR_2010.htm
     Institute of Medicine
       Review the following document to establish baseline knowledge of developing
       guidelines for a healthy school food environment: Nutrition Standards for Foods
       in Schools: Leading the Way to Healthier Youth, Institute of Medicine Report
       2007.
       http://www.iom.edu/Reports/2007/Nutrition-Standards-for-Foods-in-Schools-
       Leading-the-Way-toward-Healthier-Youth.aspx
     CDC Competitive Foods in Schools Webpage
       Review the compiled resources on implementing nutrition standards in schools.
       Listed case studies, resources, references, and fact sheets will aid in the health
       literacy component of advancing support for strong nutrition standards for foods
       and beverages in schools.
       http://www.cdc.gov/healthyyouth/nutrition/standards.htm
     USDA Team Nutrition & Healthier US School Challenge
       The goal of the Challenge is to improve the health of the nation’s children by
       creating healthier school environments and encouraging those improvements
       through awards.
       http://teamnutrition.usda.gov/HealthierUS/index.html
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      Alliance for a Healthier Generation
       Includes School Beverage and Competitive Food Guidelines that help students
       make healthier food and beverage choices in the school environment. The
       guidelines cover foods and beverages offered outside of the USDA reimbursable
       meal program and were taken into account when the USDA drafted their
       proposal, including products sold in school vending machines, a la carte lines,
       snack bars, fundraisers, and school stores. This resource offers numerous tools
       and free resources after enrollment on the website. For available resources and
       tools as well as success stories and future learning opportunities, visit
       https://schools.healthiergeneration.org/resources__tools/
       Two commonly used tools include: Product Navigator (an online searchable
       database) and the Product Calculator which determines if a product meets the
       established Guidelines after nutritional information is submitted.
       https://schools.healthiergeneration.org/wellness_categories/healthy_vending/

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Appendix B

B: Local Wellness Policy Requirements and Planning for Sustainability

Background
The Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004
(P.L. 108-265, Section 204) required school districts participating in the National School
Lunch Program, School Breakfast Program or other child nutrition programs to adopt
and implement a wellness policy by the 2006-2007 school year. The law required that
district wellness policies include:

      Goals for nutrition education, physical activity and other school-based activities
      An assurance that school meal nutrition guidelines meet the minimum federal
       school meal standards
      Guidelines for foods and beverages served or sold outside of school meal
       programs (“competitive foods”)
      Implementation plans

Healthy, Hunger-Free Kids Act of 2010 is a federal law that has renewed focus on the
importance of school wellness policies and strengthens existing requirements. The law
requires additional changes as follows:

      Permitting parents, students, school food personnel, school board members,
       administration and the public to participate in the development of wellness
       policies.
      Expands the purpose of the team to include the implementation of the local
       wellness policy with periodic review and updates.
      Requires local school districts to inform and update the public (including parents,
       students and others in the community) about the content, implementation and
       progress of school wellness policies and compare them to model school wellness
       policies.
      Requires the school district to designate at least one or more persons (within the
       district or at each school) to ensure compliance with the local wellness policy.
      Updates nutrition guidelines to meet new U.S. Department of Agriculture (USDA)
       nutrition standards and apply the standards to all foods sold for school breakfast
       and lunch programs AND to all foods sold on school grounds during the school
       day, including a la carte, vending machines, school stores, and school-sponsored
       fundraisers.

Current Legislation
The Healthy, Hunger-Free Kids Act of 2010 was effective as of October 1, 2010. USDA
advised school districts to begin reviewing their local wellness policies during school
year 2011-2012, and to the extent practicable, begin moving forward on implementing
the new requirements.

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Resources

      Food and Nutrition Services (FNS).
       A comprehensive USDA website with updated materials to help schools adhere
       to the new HHFKA requirements.
       http://www.fns.usda.gov/tn/healthy/wellnesspolicy.html
      Centers for Disease Control and Prevention (CDC).
       A wide array of resources to assist in designing, implementing, and promoting
       elements of local wellness policies.
       http://www.cdc.gov/healthyyouth/npao/wellness.htm
      School Health Guidelines to Promote Healthy Eating and Physical Activity
       (CDC). Current guidelines that synthesize the scientific evidence and best
       practices from 1995-2009 and combine healthy eating and physical activity into
       one set of evidence-based guidelines for schools serving students in kindergarten
       through 12th grade. Other educational programs within schools might also apply
       these guidelines to their settings. This document, released in September 2011,
       contains substantial literature reviews and analysis for schools responding to the
       childhood obesity epidemic.
       http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6005a1.htm?s_cid=rr6005a1
       _x
      USDA Local Wellness Policy Requirements.
       USDA is due to release the proposed rule of wellness policy requirements in
       summer of 2013 from FNS and their partners at the Department of Health and
       Human Services/CDC and the Department of Education. These three agencies
       will provide a draft plan that will provide an overview of local wellness policies,
       outline technical assistance outcomes, services, and activities on current
       resources related to the Healthy, Hunger-Free Kids Act. For the full 5 year
       technical assistance and guidance plan, visit:
       http://www.fns.usda.gov/tn/Healthy/lwp5yrplan.pdf
       In the interim, refer to the guidance memo USDA released,
       http://www.fns.usda.gov/cnd/Governance/Policy-Memos/2011/SP42-
       2011_os.pdf
      USDA Team Nutrition.
       A website set up by the USDA and Food and Nutrition Service that provides many
       resources. Links provide sample legislation, outlined local wellness policy
       requirements, discussions of the components of a wellness policy and sample
       wellness policies established in various states. The site also provides step-by-step
       procedures for developing a local wellness policy, funding a wellness policy,
       topic- specific resources, organizations, programs, curricula, research and a
       section of frequently asked questions.
       http://teamnutrition.usda.gov/Healthy/wellnesspolicy.html
      Action for Healthy Kids -- Wellness Policy Tool.

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       This tool is intended to help anyone involved in developing, implementing and
       evaluating wellness policies by providing practical guidance and how-to
       information about the wellness policy process.
       http://actionforhealthykids.org/school-programs/our-programs/wellness-policy-
       tool/
      Public Health Law Center.
       Provides publications on many topics, with a sample of resources below:
           o Healthy, Hunger-Free Kids Act of 2010: A Summary
           o Healthy, Hunger-Free Kids Act of 2010: School Wellness Policies
           o Promoting School Wellness in Minnesota Schools: Creating and
               Sustaining a School Health Council
           o Liability for Minnesota School Districts Implementing Policies to Promote
               Active Living and Healthy Eating
           o Checklist for Improving Your School Wellness Policy
           o Sample School Wellness Policy Language: School Gardens
           o Sample School Wellness Policy Language: No Food as a
               Reward/Punishment
           o Sample School Wellness Policy Language: Farm to School
           o Sample School Wellness Policy Language: Healthy Classroom
           o Sample School Wellness Policy Language: Healthy Concessions
           o Sample School Wellness Policy Language: Healthy Fundraising
           o Legal Issues Impacting Farm to School and School Garden Programs in
               Minnesota
           http://publichealthlawcenter.org/topics/special-collections/ship-
           publications-and-resources-collection.
      Wellness School Assessment Tool (WellSAT).
       Education and public health professionals can use this effective tool for
       evaluating the quality of existing school wellness policies.
       http://wellsat.org/default.aspx
      The Wellness Impact: Enhancing Academic Success Through Healthy School
       Environments.
       Provides evidence, resources, and next steps in making the connection between
       wellness policy implementation and education success indicators.
       http://www.genyouthfoundation.org/wp-
       content/uploads/2013/02/The_Wellness_Impact_Report.pdf

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Appendix C

C: School Health Councils

School Health Councils: Overview

   1. Form a new or revitalize an existing School Health Council/Team (SHC), often
      referred to as a “wellness committee.”
   2. SHCs complete an initial assessment of their school health environment and
      select strategies based on data collected. Focus on changes that target disparate
      populations and are considered high priority, high impact, and have a high level
      of support within the school and community.
   3. SHCs should obtain administrative support early and often SHCs should identify
      one contact person per site for communication with SHIP grantee and Minnesota
      Department of Health (MDH).
   4. SHCs should have an understanding of SHIP goals; policy, systems, and
      environmental (PSE) change; and sustainability planning.
   5. SHCs will network with other SHIP partners, see Figure 1 below.

Figure 1 - Networking Organization Chart for School SHIP Strategies

                                                  MDH

       SHIP grantee                          SHIP grantee                  SHIP grantee

    SHIP School Coordinator               SHIP School Coordinator       SHIP School Coordinator

              Wellness         Wellness                    Wellness    Wellness
              Champion         Champion                    Champion    Champion

                SHC             SHC                          SHC        SHC

Figure 1 illustrates how networking will be applied to facilitate ongoing dialogue and
support to SHIP grantees across the state. Tapping into this network will allow for the
sharing of ideas, identifying common barriers, and highlighting resources because many
successful practices have already been implemented and many policies have already
been adopted. The sharing of these successes across the network is essential to
maintaining SHIP support and building capacity to further advance SHIP work across
Minnesota.
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School Health Councils: Action Steps

1. Form a Committee.
       A. School health teams should have a member representative on the district
           wide school health council.
       B. Invite key stakeholders, including:
               a. Administration
               b. Classroom teachers (including PE/health specialists)
               c. School food nutrition staff
               d. School health services staff
               e. Parents
               f. Students
               g. Community partners
       C. Regular meeting times should be established. Best practice suggests a
           minimum frequency of quarterly meetings.
       D. Recommended staff knowledge, skills, and abilities include:
               a. Knowledge of policy, systems, and environment (PSE)
               b. Ability to work collaboratively with representatives from schools
               c. Knowledge of nutrition and school wellness policies
               d. Ability to work with and organize volunteers
               e. Effective communication with administration, staff, and students
       E. Identify a lead to facilitate meetings (this could be the “wellness champion”).
2. Secure administrative support.
       A. Get approval early and often.
       B. Best practice suggests having an administrator on the school health council.
       C. Keep administrative office informed on action plan updates.
3. Recruit/select a “wellness champion” and key contact person.
       A. A committee contact person should be identified to SHIP grantee & MDH,
           most likely the “champion”. This person will get updated SHIP school
           information related to resources, trainings, and networking opportunities.
       B. Have a back-up person or “co-champion” in case of staff changes.
       C. Set up initial SHC meeting and define roles/responsibilities.
4. Select a tool to assess the school health environment.
5. Develop an action plan.
       A. Using the scores on the assessment tool, select strategies from the SHIP
           menu.
       B. Develop short-term goals identifying the time frame, person responsible and
           additional resources needed.
       C. Purposefully plan for sustainability.
       D. Access training calendar on SHIP website to identify workshops that meet
           group needs.
       E. Keep administration and staff updated on action plan goals.
6. Meet regularly.
       A. Update action plans as needed.

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      B. Report updated action plans to SHIP grantee quarterly.
      C. Continue to invite key stakeholders to join the council/team.
      D. Maintain a record of agenda items and notes.
7. Provide support to staff and students as needed.
      A. Engage students and staff in the process of implementation.
      B. Network with other schools implementing similar strategies.
      C. Communicate with parents.

Resources

      Public Health Law Center. Promoting School Wellness in Minnesota Schools:
       Creating and Sustaining a School Health Council (2011).
       This document defines school health councils and the current federal and state
       laws that surround this topic. In addition, a sample policy to add in School Health
       Councils to the Minnesota School Board Association model policy is included.
       http://publichealthlawcenter.org/sites/default/files/resources/Creating%20and
       %20Sustaining%20a%20School%20Health%20Council.pdf
      NrgBalance (“energy balance”).
       A health promotion brand developed by the Center for Nutrition and Activity
       Promotion at Penn State Hershey Children’s Hospital created a school health
       council resource guide.
       http://www.nrgbalance.org/documents/School-Health-Council-
       ResourceGuide.pdf
      American Cancer Society. Improving School Health. A Guide to School Health
       Councils (2003).
       A thorough guide assisting school districts in developing new school health
       councils, strengthening existing school health councils and maintaining them as
       effective entities that support and guide school health practices, programs, and
       policies. http://www.rmc.org/CSH/Docs/Ntl_Guide_to_SHAC.pdf

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Appendix D

D: Action Plan Template – Sample for School Teams

Agenda: (Send this to council members in advance of next meeting)
Purpose of next meeting:

Meeting date:

Location:                          Start and end times:

Meeting leader:                                            Contact info:

Time     Action Item        Council Member         Disposition (information, discussion, or
frame                       Responsible            decision)

Adapted from Collaboration Handbook. Creating, Sustaining, and Enjoying the Journey, by Michael Winer
and Karen Ray (St. Paul: Amherst H. Wilder Foundation, 1994.)

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Appendix E

E: Healthy School Food Work Plan
                                                           Healthy School Food
                                             Specific Activities Proposed                                       Timeframe
                                         The specific activities that will lead to the   Staff person(s)   Month in which activity
    Reportable Milestone
                                       achievement of the reportable milestone in the     Responsible      starts to month in which
                                                         timeframe                                               activity ends

  School Health Council is formed

School Health Council has conducted
        a needs assessment

 Existing school nutrition practices
        have been reviewed

Assessment done of current school
      nutrition environment

   Action plan, including a policy
       component, is written

 School staff, teachers and other
community partners have received
              training

   Action plan, including a policy
    component is presented to
           stakeholders

   Action plan, including a policy
Healthy School Food – last updated 6/2013

    component is implemented

       Efforts are sustained

For each of your potential partner sites, please indicate where you expect them to be in the spectrum of this strategy over the
course of the grant cycle:

Partner                        At start of grant cycle   After 6 months          After 12 months            At end of grant cycle
Partner #1                     Choose an item.           Choose an item.         Choose an item.            Choose an item.
Partner #2                     Choose an item.           Choose an item.         Choose an item.            Choose an item.
Partner #3                     Choose an item.           Choose an item.         Choose an item.            Choose an item.
Partner #4                     Choose an item.           Choose an item.         Choose an item.            Choose an item.

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Appendix F

F: Farm to School Guide to Implementation

Farm to School
Implement Farm to School practices and policies which may include school gardens,
orchards, and harvest bars.

Description of Strategy
Students who eat well learn better. Farm to School strategies aim to increase the
number of fruits and vegetables children eat during the school day while also lowering
their intake of sodium, saturated fat and added sugar. Farm to School encompasses
changes within the classroom, curriculum and community. Children have increased
access to minimally processed, local food and an environment conducive to learning
about how food is grown and good nutrition is created. Some operationalized strategies
of Farm to School include cafeteria menu changes with local sourcing, harvest bar
implementation, school gardens and/or orchards, on-site greenhouses or hoop houses
as well as incorporation of these elements into the school curriculum such as FACS or
FFA classes.

Scope of Strategy
Creating sustainable policy, systems, and environmental change by increasing access to
healthier options and decreasing access to unhealthy options, enhancing health literacy
to school decision makers (providing professional and skill development trainings
leading to practice change), or by changing policy at the local level. All healthy eating
initiatives should focus on the following four goals: increasing fruits and vegetables and
decreasing sodium, fat, and added sugars.

Outcomes
Outcomes include implementing Farm to School practices and adopting a related policy.
The ultimate goal of the Farm to School strategy is to improve overall health status of
students through the increased consumption of fresh fruits and vegetables produced
from gardens on school premises or local farms. Research has shown that both Farm to
School salad bar initiatives increase fruit and vegetable consumption by at least one
serving per day and often those habits are brought home with the student.

Indicators
MDH Evaluation to make final determinations, information forthcoming

Requirements

      Review Dietary Guidelines- see Appendix A for more information on Dietary
       Guidelines
      Review Local Wellness Policies for school(s)/district sites – see Appendix B for
       more information on Local Wellness Policy Requirements
Healthy School Food – last updated 6/2013

      Attend or convene a School Health Council meeting – see Appendix C for more
       information on School Health Councils
      Complete an initial school wide needs assessment with aid from the School
       Health Council
       *Recommended tool - School Health Index (SHI)
       The School Health Index is a self-assessment and planning tool that enables
       schools to identify the strengths and weaknesses of the school’s policies and
       programs that promote health and safety. The SHI has an Elementary and
       Middle/High School version. Both versions are available free of charge, online
       and in print form. The SHI consists of eight self-assessment modules and a
       planning for improvement process. The assessment process involves members of
       the school community, parents, students, tribal council and the community to
       improve school policies, programs and services. The SHI is a nationally
       recognized, researched-based assessment tool recommended by the CDC. Many
       schools are familiar with this tool. Training for the proper use of the SHI will be
       available through the MN Department of Education upon request.
       http://www.cdc.gov/healthyyouth/SHI/index.htm
      Conduct a baseline school food environment assessment – will be forthcoming
      Action plan outlined addressing all four goal areas of increasing fruits and
       vegetables, decreasing sodium, saturated fat, and added sugar – see Appendix D
       for sample action plan template and planning calendar
      Continue to modify and update Healthy School Food work plan and
       communicate with assigned Community Specialist at MDH – see Appendix E for
       Healthy School Food Work Plan

Planning and Assessment
    School Health Council is formed
    School Health Council has conducted a needs assessment
    Existing school nutrition policies are reviewed
    Connect with MDH on specific strategy selection so that networking can start
      occurring on relevant topics. To better understand the constraints of the food
      service operation, become familiar with the food service regulations and
      standards ( http://www.ruddspark.org/get_started.aspx is a helpful resource).
      Be mindful that the slightest change in a school food service operation can have
      significant positive or negative impacts on compliance, vendor contracts, food
      preparation, equipment labor hours and financial solvency. In addition, begin to
      understand the access points for local foods in your area. A place to start is the
      MN Grown Wholesale database at http://www3.mda.state.mn.us/whlsale/.
    Become familiar with the School Day Just Got Healthier resources, which
      includes a toolkit on the federally mandated changes that are occurring with
      school meals. http://www.fns.usda.gov/cnd/healthierschoolday/
    If your target work may include additional environmental changes such as school
      gardens or salad bars, be sure to investigate planning strategies such as the

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       Creating and Growing Edible Schoolyards Manual or the Salad Bars to Schools
       information found at www.health.state.mn.us/fts.
      Assemble a team of key stakeholders. Choose diverse partners that best serve
       your situation. Engage your team in a discussion of Farm to School and the
       opportunities for this strategy within your school. You may need to begin your
       discussions individually but eventually you will want all partners to meet
       together. Begin with sustainability in mind.
           o Refer to the Farm to School Primer to understand the basic steps to
                getting started. To access online visit:
                http://www.extension.umn.edu/farm-to-school/getting-
                started/docs/MDE-primer.pdf and/or the “Farm to School: So Fresh, So
                Easy” on-line training video http://www.extension.umn.edu/farm-to-
                school/online-trainings
           o Determine your goals based on the three C’s of Farm to School: Cafeteria,
                Curriculum and Community. Be sure to create goals that include all three
                elements. If you are just beginning, keep these goals simple to ensure
                some early wins. This will energize your team to continue.
      Develop an action plan designed to implement Farm to School strategy
       components. Prioritize the plan based on feasibility, cost, resources, and
       sustainability.
           o See the Farm to School Annual Planning Tool for assistance. To access
                online visit:
                http://www.health.state.mn.us/divs/hpcd/chp/cdrr/nutrition/docsandpd
                f/FarmtoSchoolannualplanningtool.pdf
           o Be sure to include plans to assess and potentially change policies related
                to Farm to School.
      Develop your evaluation plan before you begin implementing Farm to School
       strategies. Set realistic expectations, work towards achieving these expectations
       and determine what’s working and what’s not working.
           o See Farm to School Evaluation Toolkit from the National Farm to School
                Network. To access online visit:
                http://www.farmtoschool.org/files/publications_385.pdf
      Work with school staff, teachers, and other community partners to attend
       trainings and other opportunities based on the needs that are identified in the
       prioritized action plan.
           o Refer to the Basecamp calendar for technical assistance opportunities
                that MDH might be able to provide on selected strategy components.
           o Educate school staff, students, parents, and the community on Farm to
                School strategy components.
      Network with other SHIP grantees
      Plan your educational outreach and promotion activities. Get the word out about
       your program! Engage students and community partners in the promotion of
       selected Farm to School practices. There are many great ideas and resources you

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       can use. To access online visit: http://www.health.state.mn.us/fts or www.mn-
       farmtoschool.umn.edu

Implementation and Growth
   Action plan, including a policy component, is presented to stakeholders
   Determine the roles of the various partners involved in implementing the plans.
     Provide support to partners as needed, such as assisting with gathering the
     information and resources they need to complete their tasks.
   Ensure ongoing communication between partners during the implementation
     phase.
   Be sure to deliver on your commitments made in your plan.
   Meet with your team of school partners and community members responsible
     for school wellness, food and nutrition, and administration to review the initial
     action plan and the progress being made.
         o Continue to gather additional input from key stakeholders.
         o Review progress, setbacks, obstacles and unforeseen opportunities.
         o Finalize action plan so next steps are clearly identified. Action plans
            should clearly identify goals, steps, responsible party, timeline, budget,
            resources, outcome measures and plans for sustainability.
   Present action plan and progress to school administration, school board, and
     other community elected officials, key decision makers, and community groups.
   Hold follow-up meeting with school and community stakeholders to review
     action plan, priorities, identify next steps and discuss existing barriers.

Sustain
    Action plan, including a policy component, is implemented
    Farm to School initiatives promoted to all school partners, included community
      partners.

Modifications to work plans for this strategy can be made in consultation with your
assigned Community Specialist. Please refer to the training and technical assistance
below for resources you can use to help you identify possible courses of action.

Training and Technical Assistance
Refer to the Basecamp calendar for technical assistance that MDH might be able to
provide on selected strategy components.

Additional Resources

   Resources for Planning and Assessment
       Farm to School Self-Assessment
          http://www.health.state.mn.us/divs/hpcd/chp/cdrr/nutrition/docsandpdf/se
          lf_assessment.pdf
       Legal Issues Impacting Farm to School and School Garden Programs in MN

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           http://www.publichealthlawcenter.org/sites/default/files/resources/ship-
           f2s-school%20garden%20legal%20issues-2011.pdf
          Serving Locally Grown Produce in Food Facilities
           A MDH, MDA, University of MN authored factsheet with basic statute
           information.
           http://www.health.state.mn.us/healthreform/ship/techassistance/locally_gr
           ownfactsheet.pdf
          On-farm Food Safety Information for K-12 Food Service Personnel
           http://safety.cfans.umn.edu/documents/F2s%20OnFarm%20FoodSafety%20
           Qs.pdf

   Existing Program/Support Resources
        Local Technical Assistance
           Identify people in your area that are available to provide support and
           assistance.
           http://www.health.state.mn.us/divs/hpcd/chp/cdrr/nutrition/docsandpdf/T
           hisTeamisReadytoHelp.pdf
        Minnesota Farm to School Programs
           Learn what other schools in Minnesota are doing to bring fresh, local
           produce to their students.
           http://www.farmtoschool.org/mn/programs.htm
        National Farm to School Network
           Learn about Farm to School programs across the nation.
           http://www.farmtoschool.org/index.php

   Action Plan Resources
        Resource list
          A list of resources from getting started to formal adoption of local
          wellness policies.
          http://www.health.state.mn.us/divs/hpcd/chp/cdrr/nutrition/FTS/resources.
          html
        MN Farm to School
          The most updated MN resource with information on food service, farmers,
          parents, teachers and school gardens.
          http://www.extension.umn.edu/farm-to-school/
          Review the online trainings and the resource lists for a wealth of information.
          http://www.extension.umn.edu/farm-to-school/online-trainings/
        Let’s Move Salad Bars to Schools
          This MN website offers templates, best practices and a variety of resources
          that can be used in any school to obtain, implement or enhance school salad
          bars.
          http://www.health.state.mn.us/divs/hpcd/chp/cdrr/nutrition/FTS/saladbars.
          html

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          Cultivating Childhood Wellness Through Gardening
           This free online video series produced in Wisconsin provides relevant
           information for schools and childcare settings incorporating schoolyard
           gardens.
           https://connect.wisconsin.gov/dhsgotdirt1
          USDA Team Nutrition
           In addition to numerous resources and helpful information, Team Nutrition
           has recently released two new curriculums, The Great Garden Detective
           Adventure and Dig In, offering interactive and exploratory lessons to connect
           school gardens with health literacy messages.
           http://teamnutrition.usda.gov/
          Agriculture in the Classroom
           The Minnesota Department of Agriculture is due to release a statewide
           garden curriculum linked to standards that schools may wish to implement.
           Piloting of the curriculum began in spring 2013.
           http://www.mda.state.mn.us/kids.aspx

   Evaluation Resources
       Farm to School Evaluation Toolkit
          The Farm to School Evaluation Toolkit is an evaluation tool from the National
          Farm to School Network and is useful for measuring program impact on fruit
          and vegetable consumption among students. This toolkit includes three main
          evaluation tools: School Lunch Recall, Fruit and Vegetable Neophobia Scales,
          and Interview Guides to facilitate discussions with stakeholders.
          http://www.farmtoschool.org/files/publications_385.pdf
       Farm to School and School Garden Research Consortium
          The Consortium was created to coordinate research & evaluation efforts to
          strengthen farm to school and garden-based education programs, practices,
          and policies. Create an account to join the Farm to School listserv.
          http://datadorksunite.ning.com/

Resources for Sustaining Long-Term Farm to School Changes
        Delivering More: Scaling Up Farm to School Programs
           https://www.foodsecurity.org/pub/Delivering_More-
           Scaling_up_Farm_to_School.pdf
        Public Health Law Center Sample School Wellness Policy: Farm to School
           http://www.publichealthlawcenter.org/sites/default/files/resources/ship-
           fs2-schoolwellnesssamplepolicylanguage-2011FarmtoSchool.pdf
        Michigan Farm to School Wellness Policy
           http://www.mifarmtoschool.msu.edu/assets/farmToSchool/docs/STEP2_Sa
           mple_FTSLanguage_WellnessPrograms.pdf
        Model Farm to School Wellness Policy
           http://www.foodsecurity.org/F2Cwellness.html

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Appendix G

G: Healthy School Food Options: Outside of the USDA Reimbursable Meal
Program Guide to Implementation

Healthy School Food Options
Healthy School Food Options involves implementation of policies and practices that
increase access to healthy snacks and beverages and limit unhealthy snack and beverage
choices through lowering sodium, saturated fat, and added sugar while increasing fruit
and vegetables within the school environment but outside of the USDA reimbursable
meal program; such as snack carts, a la carte, vending, concessions, school store, food
rewards, fundraising, and celebration/parties.

Description of Strategy
This strategy supports increased fruit and vegetable intake and decreased sodium,
saturated fat, and added sugars in Competitive Foods. Competitive Foods are defined by
the USDA as foods and beverages, regardless of nutritional value, that are sold
separately from the USDA school meals program. Due to the Healthy, Hunger-Free Kids
Act the USDA is required to issue nutrition standards for all foods sold in schools with
the goal of eliminating unhealthy foods in vending machines, snack bars, a la carte, and
other foods sold outside of the federally-reimbursed school meal program. Adopting
Smart Snacks in Schools (as currently termed) guidelines will be a federal requirement
for participation in the federal school meal programs; however, the final rule is yet to be
released. To view the proposed rule that was released early in 2012, visit:
http://www.fns.usda.gov/pressrelease/2013/001913. Improving the nutritional
content/value of snacks available in schools may also directly impact student’s eating
behaviors, as research shows that over 40 percent of young people have a snack at
school7. Until the USDA releases the final federal rule, schools can work towards this
strategy by implementing competitive food guidelines at the local level to get a jump on
adopting the federal competitive food guidelines that are forthcoming.

Specifically, schools can restrict the availability of less healthy foods by adopting
standards for the foods sold; restricting access to vending machines, banning food as
rewards in the classroom; or by prohibiting food sales at certain times of the school
day.8 The Institute of Medicine recommends that competitive foods be limited to
nutritious foods, including fruits and vegetables.9

Implementation of this strategy will be unique to each school due to differing results of
school environment assessments. All strategies can be tailored to accommodate age
and developmental differences.

Scope of Strategy
The scope of this strategy includes creating sustainable policy, systems, and
environmental change by increasing access to healthier options and decreasing access
to unhealthy options, enhancing health literacy to school decision makers (providing

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professional and skill development trainings leading to practice change), or by changing
policy at the local level. All healthy eating initiatives should focus on the following four
goals: increasing fruits and vegetables and decreasing sodium, saturated fat, and added
sugars.

Outcomes
Outcomes include implementing Smart Snacks in School practices and policies. The
ultimate goal of the Healthier School Food Options strategy is to improve overall health
status of students through the increased consumption of fresh fruits and vegetables and
a reduction in sodium, saturated fat, and added sugar intake at school.

Indicators
MDH Evaluation to make final determinations, information forthcoming

Requirements

      Review Dietary Guidelines- see Appendix A for more information on Dietary
       Guidelines
      Review Local Wellness Policies for school(s)/district sites – see Appendix B for
       more information on Local Wellness Policy Requirements
      Attend or convene a School Health Council meeting – see Appendix C for more
       information on School Health Councils
      Complete an initial school wide needs assessment with aid from the School
       Health Council
       *Recommended tool: School Health Index (SHI)
       The School Health Index is a self-assessment and planning tool that enables
       schools to identify the strengths and weaknesses of the school’s policies and
       programs that promote health and safety. The SHI has an Elementary and
       Middle/High School version. Both versions are available free of charge, online
       and in print form. The SHI consists of eight self-assessment modules and a
       planning for improvement process. The assessment process involves members of
       the school community, parents, students, tribal council and the community to
       improve school policies, programs and services. The SHI is a nationally
       recognized, researched-based assessment tool recommended by the CDC. Many
       schools are familiar with this tool. Training for the proper use of the SHI will be
       available through the MN Department of Education upon request.
       http://www.cdc.gov/healthyyouth/SHI/index.htm
      Conduct a baseline school food environment assessment – will be forthcoming
      Action plan outlined addressing all four goal areas of increasing fruits and
       vegetables, decreasing sodium, saturated fat, and added sugar -- see Appendix D
       for sample school action plan template and planning calendar
      Continue to modify and update Healthy School Food Work Plan and
       communicate with assigned Community Specialist at MDH -- see Appendix E for
       Healthy School Food Work Plan for local public health use

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Planning and Assessment

      School Health Council is formed
      School Health Council has conducted a needs assessment
      Review Dietary Guidelines information and resources- see Appendix A
      Existing school nutrition policies are reviewed
      Connect with MDH on specific strategy selection so that networking can begin on
       relevant topics.
      Assemble a team of key stakeholders. Choose diverse partners that best serve
       your situation.
      Check out current legislation on Smart Snacks in Schools for the final rule
       release, http://www.fns.usda.gov/pressrelease/2013/001913
      Review applicable additional resources in the final section of this document
      Develop an action plan designed to implement Healthy School Food Options
       strategy components. Prioritize the plan based on feasibility, cost, resources, and
       sustainability.
           o Be sure to include plans to assess and potentially change policies related
                to foods available and sold.
      Develop your evaluation plan before you begin implementing Healthy School
       Food Options strategies. Set realistic expectations, work towards achieving these
       expectations and determine what’s working and what’s not working.
      Work with school staff, teachers, and other community partners to attend
       trainings and other opportunities based on the needs that are identified in the
       prioritized action plan.
           o Refer to Basecamp calendar for technical assistance opportunities that
                MDH might be able to provide on selected strategy components. Educate
                school staff, students, parents, and the community on strategy
                components.
           o Generate excitement over selected SHIP strategy components.
      Network with other SHIP grantees
      Plan your educational outreach and promotion activities. Get the word out about
       your program! Engage students and community partners in the promotion of
       Healthy School Food Options. There are many great ideas and resources you can
       use, see the Additional Resources section.

Implementation and Growth

      Action plan, including a policy component, is presented to stakeholders
      Determine the roles of the various partners involved in the implementation plan.
       Provide support to partners as needed, such as assisting with gathering the
       information and resources they need to complete their tasks.
      Ensure ongoing communication between partners during the implementation
       phase.

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      Be sure to deliver on your commitments made in your plan.
      Meet with your team of school partners and community members (perhaps food
       distributors) responsible for school wellness, food and nutrition, and
       administration to review the initial action plan and discuss progress.
           o Continue to gather additional input from key stakeholders, including
               students.
           o Review progress, setbacks, obstacles and unforeseen opportunities.
           o Finalize the action plan so that next steps are clearly identified. Action
               plans should clearly identify goals, steps, responsible party, timeline,
               budget, resources, outcome measures and plans for sustainability.
      Present the action plan and progress to school administration, school board, and
       other community elected officials, and key decision makers.
      Hold a follow-up meeting with school and community stakeholders to review
       action plan and priorities and to identify next steps and existing barriers.

Sustain

      Action plan, including a policy component, is implemented- see Appendix B for
       Local Wellness Policy Requirements and sustainability
      Healthy School Food Options promoted to all school partners, including
       community partners.

Modifications to work plans for this strategy can be made in consultation with your
assigned Community Specialist. Please refer to the training and technical assistance
noted below for resources you can use to identify possible courses of action.

Training and Technical Assistance
    Refer to the Basecamp calendar for technical assistance that MDH might be able
      to provide on selected strategy components.
    Plan for future learning opportunities that the Alliance for a Healthier
      Generation offers.
      https://schools.healthiergeneration.org/resources__tools/learning_opportunitie
      s/

Additional Resources
   Center for Preventing Childhood Obesity/Robert Wood Johnson Foundation
      Making Schools the Model for Healthier Environments Toolkit
      Includes an extensive list of resources related to making improvements to the
      school food environment.
      http://www.reversechildhoodobesity.org/webfm_send/207
   Food Research and Action Center
      Improving the School Food Environment: Making Competitive Foods Healthier
      http://org2.democracyinaction.org/o/5118/p/salsa/web/common/public/conten
      t?content_item_KEY=8793

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      Center for Science in the Public Interest
       Review the School Foods Tool Kit for sample goals, fact sheets, model policies,
       surveys and more that will assist you in the development of an action plan.
       Please note, however, that this toolkit was developed in 2003 and will not
       incorporate new federal legislation.
       http://www.cspinet.org/schoolfoodkit/
      Public Health Law Center- School Food Policies
       Informational fact sheets and sample policies
       http://phlc.stylefish.com/topics/healthy-eating/school-food-policies

Tactic Specific Resources (this is not an exhaustive list)

Classroom Snacks/Snack Carts/School Stores
     Eat Right – The American Dietetic Association put together this list of 25 healthy
       snacks for kids. This could be used as a parent information piece.
       http://www.eatright.org
     A thorough spreadsheet of snacks that meet IOM nutritional standards.
       http://www.dakmed.org/cass/healthy-snack-list/
     Starting a School Store. A site that utilizes classroom building skills and
       incorporates them into the running of a school store.
       http://www.raymondgeddes.com/school-store-academy.html

Vending Machines/Concessions
    National Policy and Legal Analysis Network to Prevent Childhood Obesity. District
      Policy Establishing a Healthy Vending Program. This model will help school
      districts develop a vending program that fits within any established wellness
      policy by making sure products meet the policy’s nutritional standards. Model
      policies of healthy vending agreements are also available on the site.
      http://www.nplanonline.org/nplan/products/district-policy-establishing-healthy-
      vending-program
    Eat Well Work Well. A wide array of resources and tools specific to vending,
      including: vending machine assessment tools, sample vending policies, and
      sample letters to vendors.
      http://www.eatwellworkwell.org/education-tools.htm#vending

A La Carte
     Competitive Foods Calculator. USDA’s Healthier US School Challenge.
       http://healthymeals.nal.usda.gov/hsmrs/HUSSC/calculator.html
     Meeting the Competitive Foods Criteria for the Healthier US School Challenge
       (HUSSC). Provides objectives, lessons plans, and handouts specific to the HUSSC
       program.
       http://www.fns.usda.gov/tn/HealthierUS/NFSMI/lesson5.pdf

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